Healthcare Provider Details

I. General information

NPI: 1689616450
Provider Name (Legal Business Name): CANDACE SUE KASPER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 KELLER SPRINGS RD SUITE 1104
CARROLLTON TX
75006-4829
US

IV. Provider business mailing address

2840 KELLER SPRINGS RD SUITE 1104
CARROLLTON TX
75006-4829
US

V. Phone/Fax

Practice location:
  • Phone: 214-483-2100
  • Fax: 214-483-2104
Mailing address:
  • Phone: 214-483-2100
  • Fax: 214-483-2104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberF9650
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: